Marital status, health and mortality

Abstract

Marital status and living arrangements, along with changes in these in mid-life and older ages, have implications for an individual's health and mortality. Literature on health and mortality by marital status has consistently identified that unmarried individuals generally report poorer health and have a higher mortality risk than their married counterparts, with men being particularly affected in this respect. With evidence of increasing changes in partnership and living arrangements in older ages, with rising divorce amongst younger cohorts offsetting the lower risk of widowhood, it is important to consider the implications of such changes for health in later life. Within research which has examined changes in marital status and living arrangements in later life a key distinction has been between work using cross-sectional data and that which has used longitudinal data. In this context, two key debates have been the focus of research; firstly, research pointing to a possible selection of less healthy individuals into singlehood, separation or divorce, while the second debate relates to the extent to which an individual's transitions earlier in the life course in terms of marital status and living arrangements have a differential impact on their health and mortality compared with transitions over shorter time periods. After reviewing the relevant literature, this paper argues that in order to fully account for changes in living arrangements as a determinant of health and mortality transitions, future research will increasingly need to consider a longer perspective and take into account transitions in living arrangements throughout an individual's life course rather than simply focussing at one stage of the life course.

Full text

Maturitas
73 (2012) 295–
299
Contents
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available
at
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Maturitas
j
ourna
l
h
o
me
page:
www.elsevier.com/locate/maturitas
Review
Marital
status,
health
and
mortality
James
Robardsa,∗,
Maria
Evandroua,b,c,
Jane
Falkinghama,b,
Athina
Vlachantonia,b,c
aEPSRC
Care
Life
Cycle,
Social
Sciences,
University
of
Southampton,
SO17
1BJ,
UK
bESRC
Centre
for
Population
Change,
Social
Sciences,
University
of
Southampton,
SO17
1BJ,
UK
cCentre
for
Research
on
Ageing,
Social
Sciences,
University
of
Southampton,
SO17
1BJ,
UK
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
6
August
2012
Accepted
13
August
2012
Keywords:
Older
people
Marital
status
Living
arrangements
Informal
care
Health
Mortality
a
b
s
t
r
a
c
t
Marital
status
and
living
arrangements,
along
with
changes
in
these
in
mid-life
and
older
ages,
have
implications
for
an
individual’s
health
and
mortality.
Literature
on
health
and
mortality
by
marital
status
has
consistently
identified
that
unmarried
individuals
generally
report
poorer
health
and
have
a
higher
mortality
risk
than
their
married
counterparts,
with
men
being
particularly
affected
in
this
respect.
With
evidence
of
increasing
changes
in
partnership
and
living
arrangements
in
older
ages,
with
rising
divorce
amongst
younger
cohorts
offsetting
the
lower
risk
of
widowhood,
it
is
impor-
tant
to
consider
the
implications
of
such
changes
for
health
in
later
life.
Within
research
which
has
examined
changes
in
marital
status
and
living
arrangements
in
later
life
a
key
distinction
has
been
between
work
using
cross-sectional
data
and
that
which
has
used
longitudinal
data.
In
this
context,
two
key
debates
have
been
the
focus
of
research;
firstly,
research
pointing
to
a
possible
selection
of
less
healthy
individuals
into
singlehood,
separation
or
divorce,
while
the
second
debate
relates
to
the
extent
to
which
an
individual’s
transitions
earlier
in
the
life
course
in
terms
of
marital
status
and
liv-
ing
arrangements
have
a
differential
impact
on
their
health
and
mortality
compared
with
transitions
over
shorter
time
periods.
After
reviewing
the
relevant
literature,
this
paper
argues
that
in
order
to
fully
account
for
changes
in
living
arrangements
as
a
determinant
of
health
and
mortality
transitions,
future
research
will
increasingly
need
to
consider
a
longer
perspective
and
take
into
account
transitions
in
living
arrangements
throughout
an
individual’s
life
course
rather
than
simply
focussing
at
one
stage
of
the
life
course.
© 2012 Elsevier Ireland Ltd. All rights reserved.
Contents
1.
Introduction
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2.
Changes
in
marital
status
and
living
arrangements
in
mid-
and
later
life
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3.
Marital
status,
living
arrangements
and
health
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3.1.
Quality
of
relationship
matters.
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3.2.
Selection
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3.3.
Cohort
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3.4.
Life
history
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4.
Marital
status,
living
arrangements
and
mortality
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5.
Conclusions
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Contributors
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Competing
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Provenance
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peer
review
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References
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∗Corresponding
author.
Tel.:
+44
023
8059
4744.
E-mail
addresses:
james.robards@soton.ac.uk
(J.
Robards),
maria.evandrou@soton.ac.uk
(M.
Evandrou),
j.c.falkingham@soton.ac.uk
(J.
Falkingham),
a.vlachantoni@soton.ac.uk
(A.
Vlachantoni).
0378-5122/$
–
see
front
matter ©
2012 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.maturitas.2012.08.007

296 J.
Robards
et
al.
/
Maturitas
73 (2012) 295–
299
1.
Introduction
Numerous
studies
within
demographic
research
have
high-
lighted
that
health
and
mortality
outcomes
for
married
persons
are
better
than
for
unmarried
persons
[1,2],
and
this
is
particularly
the
case
for
men
[3,4].
Subsequent
research
has
sought
to
explore
the
extent
of
‘marriage
selection’
by
which
healthier
persons
are
selected
into
marital
unions,
while
less
healthy
individuals
either
remain
single
or
are
more
likely
to
become
separated,
divorced
or
widowed
[5,6].
Research
has
also
examined
the
extent
to
which
marriage
provides
‘protection’
against
adverse
health
outcomes,
through
modified
health
behaviours
and
social
networks
arising
from
the
union
[7].
In
some
cases
evidence
for
both
theories
has
been
identified
[8,9].
In
the
context
of
social
changes
at
older
ages,
marital
status
and
living
arrangements
in
mid-
and
later
life
are
crucial
in
rela-
tion
to
subsequent
forms
of
informal
care
provision
(and
receipt)
and
health
and
mortality
outcomes
[10,11].
Recent
increases
in
single-person
households
are
not
confined
to
younger
ages,
with
the
trend
towards
rising
solo
living
also
noted
among
older
people
[12].
Moreover,
transitions
in
marital
status
at
younger
old
ages
with,
for
example,
higher
rates
of
divorce
amongst
cohorts
born
in
the
1960s
than
their
parental
generation
born
in
the
1930s
[13],
look
likely
to
have
longer
term
impacts
given
the
increased
life
expectancy
and
wealthier,
longer
and
healthier
lives
which
have
still
to
play
out
for
those
cohorts
currently
in
mid-life
or
early
old
age.
This
paper
discusses
research
on
health
and
mortality
outcomes
for
different
marital
states
and
transitions
between
states.
Based
on
changes
in
marital
status
and
living
arrangements
taking
place
at
middle
and
older
age,
this
paper
argues
that
future
research
should
take
into
account
marital
status
and
living
arrangements
across
the
life
course
when
considering
the
health
and
mortality
outcomes
from
different
living
arrangements.
Some
research
has
already
taken
a
longer
period
of
the
life
course
into
consideration
in
estimating
mortality
and
health
outcomes
at
older
ages
[14–16];
further
research
building
on
this
evidence
base
is
required.
2.
Changes
in
marital
status
and
living
arrangements
in
mid-
and
later
life
Within
the
United
Kingdom
(UK)
and
elsewhere,
there
is
increasing
diversity
in
living
arrangements
and
marital
status
in
the
mid-life
and
at
older
ages.
In
part
this
reflects
the
rise
in
the
divorce
rate
at
mid
and
older
ages
[17,18],
along
with
changes
in
the
patterns
of
repartnering
[19]
and
the
reduced
risk
of
widowhood.
Internationally,
the
proportion
of
older
people
living
alone
was
rising
until
the
early
1990s
[20],
since
which
there
has
been
a
slow-
down
[18].
This
slowdown
is
related
to
increasing
life
expectancy
at
young
old
ages,
which
in
turn
has
led
to
increasing
proportions
of
older
people
living
in
couple-only
households.
However,
as
those
cohorts
born
in
the
1950s
and
1960s
begin
to
enter
old
age,
it
is
unclear
whether
this
trend
towards
living
in
a
couple
will
con-
tinue,
or
whether
more
future
elders
will
enter
later
life
living
solo.
Recent
statistics
for
the
UK
identify
that
in
the
45–64
years
age
group
there
has
been
an
increase
in
the
percentage
living
alone
by
36%
between
2001
and
2011,
reflecting
the
lower
proportion
of
this
age
group
who
are
married
(77%
in
2001
to
70%
in
2011)
and
the
increase
in
those
who
never
married
or
are
divorced
(18%
in
2001
to
27%
in
2011)
[21].
Similarly,
Demey
et
al.
has
found
a
rise
in
the
proportion
of
people
currently
in
mid-life
who
are
living
without
a
partner,
either
through
divorce
or
through
never
having
partnered
[22].
Recent
changes
in
divorce
patterns
at
middle
and
older
ages
are
likely
to
lead
to
an
increasing
diversification
of
living
arrange-
ments
at
older
ages.
Given
this,
cross-sectional
indicators
of
current
marital
status
are
likely
to
become
of
less
conceptual
use
as
dif-
ferent
individuals
with
the
same
current
marital
status
may
have
experienced
very
different
trajectories
in
reaching
that
state,
with
some
being
in
the
same
union
throughout
their
lives
whilst
others
may
have
experienced
multiple
partnership
formation
and
dissolu-
tion.
Understanding
the
relationship
between
living
arrangements
and
health
across
the
life
course
may
therefore
be
of
increasing
importance.
3.
Marital
status,
living
arrangements
and
health
A
consistent
finding
from
research
investigating
health
out-
comes
of
different
marital
statuses
and
transitions
in
marital
statuses,
is
evidence
of
the
poorer
health
of
divorced
and
single
men
relative
to
their
married
counterparts;
moreover
there
also
appears
to
be
a
gender
effect
with
divorced
and
single
men
experienc-
ing
poorer
health
outcomes
than
single
women
[3,4,23–25].
These
findings
have
provoked
questions
on
whether
there
is
some
form
of
selection
of
less
healthy
individuals
into
non-marital
states
or
whether
being
married
offers
a
‘protective
effect’
for
health
and
the
transition
from
being
married
into
being
unmarried
has
an
adverse
impact
on
health.
The
picture
is
further
complicated
by
the
fact
that
such
transitions
in
partnership
status
may
be
accompanied
by
temporary
changes
(for
example,
health
may
undergo
a
temporary
decline
around
the
time
of
the
marital
dissolution)
which
are
not
adequately
captured
in
cross-sectional
data.
Additionally,
caution
is
needed
in
treating
both
the
unmarried
and
married
as
homoge-
nous
groups
as
both
the
route
into
being
‘unmarried’
and
the
quality
of
the
marital
relationship
have
both
been
found
to
matter.
Goldman
et
al.,
using
data
from
the
US
Longitudinal
Study
of
Aging
(1984–1990),
identified
that
marital
status
is
associated
with
health
and
survival
outcomes
at
the
oldest
ages,
with
widowed
men
being
at
a
higher
risk
of
being
disabled
than
married
men
[26].
How-
ever,
unmarried
persons
at
older
ages
were
found
to
have
variations
in
health
outcomes;
widowed
persons
had
poorer
health
but
this
was
not
the
case
among
divorced
or
single
persons.
The
paper
sug-
gests
that
frail
single
persons
may
have
died
before
reaching
older
ages
(the
selection
effect)
and
that
the
surviving
older
single
per-
sons
would
not
have
experienced
stresses
and
strains
associated
with
divorce
and
widowhood.
Therefore
it
is
argued
that
because
of
their
diversity
of
experiences,
the
unmarried
should
not
be
treated
as
a
homogenous
group.
3.1.
Quality
of
relationship
matters
It
may
also
be
the
case
that
the
married
should
not
be
treated
as
a
homogenous
group.
Looking
only
at
a
sample
aged
50+
and
in
their
first
marriage,
Bookwala
found
that
uncaring
and
unhelpful
spousal
behaviours
was
associated
with
poorer
physical
health
and
that
such
behaviours
outweighed
positive
spousal
behaviours
in
contributing
to
poorer
physical
health
[27].
3.2.
Selection
matters
The
degree
to
which
less
healthy
persons
are
‘selected’
into
singlehood,
separation
or
divorce
is
best
investigated
using
lon-
gitudinal
data,
with
information
on
health
both
before
and
after
changes
in
marital
status.
Among
studies
exploring
health
status
pre-transition,
Joung
et
al.
found
that
only
divorce
was
associated
with
health
status
[5].
This
research
showed
that
married
persons
with
four
or
more
health
complaints
and
two
or
more
chronic
conditions
were
1.5
and
2
times
more
likely
to
become
divorced
than
persons
without
these
problems
at
the
baseline.
Williams
and
Umberson
make
similar
findings
using
data
from
the
US
[28].
A
life
course
perspective
was
used
to
assess
the
impact
of
marital
sta-
tus
and
marital
transitions
on
subsequent
changes
in
self-assessed

J.
Robards
et
al.
/
Maturitas
73 (2012) 295–
299 297
Table
1
Odds-ratios
from
logistic
regression
analysis
of
long-term
illness
1991
(ages
60–79).
Men Women
Model
1
Model
2
Model
1
Model
2
OR OR OR
OR
Age 1.03*** 1.03*** 1.07*** 1.07***
Marital
history
1st
marriage
– long
term
(20+
years)
1.00
1.00
1.00
1.00
1st
marriage
–
since
1971
0.77
0.74*0.85
0.83
Remarried
–
long
term
(20+
years)
1.24*** 1.26*** 1.40*** 1.34***
Remarried
since
1971,
previously
widowed
0.91
0.93
1.05
1.00
Remarried
since
1971,
previously
divorced 1.05
1.01
1.25** 1.16*
Widowed-long
term
(20+
years) 1.33*1.10
1.18*** 1.01
Widowed-intermediate
(10–19
years)
1.35*** 1.18*1.11** 0.96
Widowed-recent
(<10
years)
1.26*** 1.12*1.07*0.96
Divorced-long
term
(20+
years)
1.40*1.14
1.42*** 1.15
Divorced-intermediate
(10–19
years)
1.59*** 1.35*** 1.37*** 1.15
Divorced-recent
(<10
years)
1.53*** 1.39** 1.72*** 1.49**
Never-married
1.22*** 0.97
1.17** 1.04
Socioeconomic
variables
Educational
qual.1971
(ref.
none) 0.84*** 0.88***
Tenure/car
score
1971–91
0.94*** 0.92***
Social
class
score
1971–81
0.89***
Current
marital
status
All
in
1st
marriage
1.00
1.00
1.00
1.00
All
remarried
1.12** 1.13** 1.26*** 1.20***
All
widowed 1.29*** 1.14** 1.10*** 0.97
All
divorced
1.54*** 1.33*** 1.45*** 1.21***
Never-married 1.22*** 0.97
1.17** 1.04
N
33,686
41,341
Source:
Grundy
and
Tomassini
[14],
adjusted
from
Table
3.
Note:
This
table
was
produced
using
the
ONS
Longitudinal
Study
with
help
provided
by
staff
of
the
Centre
for
Longitudinal
Study
Information
&
User
Support
(CeLSIUS).
CeLSIUS
is
supported
by
the
ESRC
Census
of
Population
Programme
(Award
Ref:
RES-348-25-0004).
Census
output
is
Crown
copyright
and
is
reproduced
with
the
permission
of
the
Controller
of
HMSO
and
the
Queen’s
Printer
for
Scotland.
*Significant
at
10%.
** Significant
at
5%.
*** Significant
at
1%.
physical
health
of
men
and
women
aged
24
and
over.
Results
indi-
cate
that
there
are
negative
physical
health
consequences
of
divorce
or
widowhood
which
increase
with
age,
and
that
the
health
of
women
is
less
impacted
upon
by
dissolution,
without
any
dis-
cernible
protective
effects
from
marital
unions.
Finally,
research
which
has
considered
the
impact
of
transitions
out
of
marriage
(separation
and
widowhood)
on
self-reported
mental
health
found
that
such
transitions
were
significantly
associated
with
a
deterio-
ration
mental
health
[29].
3.3.
Cohort
matters
Moreover
the
relationship
between
health
and
marital
status
may
not
be
constant
over
time,
reflecting
differences
in
the
life
histories
of
men
and
women
from
different
birth
cohorts.
Focusing
on
cohort
differences
in
changes
to
marital
status
in
the
US
context,
Liu
found
that
older
persons
born
in
the
1950s
who
experienced
a
divorce
were
relatively
more
likely
to
report
poorer
health
than
divorcees
who
had
been
born
in
the
1940s.
By
contrast,
widowhood
was
associated
with
poorer
health
for
the
1910s
cohort
than
for
the
1920s
cohort.
It
is
suggested
that
the
economic
context
for
those
born
in
the
1950s
may
have
an
influence;
inhospitable
economic
conditions
in
the
1970s
making
for
weaker
employment
prospects
resulting
in
adverse
health
outcomes
[16].
Taking
a
similar
cohort
approach,
Waldron
et
al.
selects
a
younger
sample
using
data
from
the
US
National
Longitudinal
Study
of
Young
Women.
Women
aged
24–34
at
the
beginning
of
two
successive
5-year
follow-up
intervals
(1978–1983
and
1983–1988)
were
followed
over
time
to
explore
the
relationship
between
ini-
tial
health
status
and
subsequent
health.
Although
there
were
differences
in
health
by
marital
status
amongst
the
first
cohort,
no
differences
were
found
amongst
the
second,
highlighting
the
importance
of
taking
into
account
the
external
context
faced
by
each
cohort
at
the
same
stage
of
the
life
course
[30].
3.4.
Life
history
matters
With
the
identification
that
persons
who
make
a
transition
to
a
non-marital
status
have
a
poorer
health
status,
there
is
a
growing
body
of
work
on
the
short-
or
long-term
impact
of
marital
transi-
tions
on
health
according
to
the
timing
of
such
transitions.
Among
the
body
of
work
taking
a
long-term
perspective
on
marital
his-
tory
is
the
work
of
Grundy
and
Tomassini.
This
used
the
Office
for
National
Statistics
Longitudinal
Study
to
explore
the
health
bene-
fits
of
marriage
for
75,000
men
and
women
aged
60–79
years
in
1991
taking
into
account
individual’s
marital
status
reported
in
1971,
1981
and
1991.
Table
1
presents
results
from
Grundy
and
Tomassini
and
shows
the
odds
of
reporting
a
long-term
illness
at
the
1991
census.
Two
features
stand
out:
first
that
marital
history
matters
(as
highlighted
in
model
1)
and
second
that,
in
line
with
other
research,
the
relationship
between
marital
experience
and
later
life
health
and
mortality
is
modified
by
socio-economic
fac-
tors.
The
odds
of
reporting
a
long-term
illness
for
never
married
and
long-term
divorced
or
widowed
men
were
not
significantly
raised
once
socio-economic
background
was
controlled
for
(model
2).
For
women,
however,
raised
odds
for
the
recently
divorced,
long-term
remarried
and
those
remarried
since
1971
remained
even
after
controlling
for
socio-economic
background
(model
2).
The
inclusion
of
socio-economic
status
considerably
modified
asso-
ciations,
especially
for
women
and
the
never-married.
The
research

298 J.
Robards
et
al.
/
Maturitas
73 (2012) 295–
299
identifies
both
marital
protection
and
selection
effects;
marriage
having
the
potential
to
bring
socio-economic
advantage,
while
remaining
unmarried
or
marital
termination
making
achievement
of
socio-economic
advantage
less
likely
[14].
The
benefit
of
a
marital
history
approach
is
evident
in
the
detail
provided
for
the
remarried
groups.
Given
recent
changes
in
patterns
of
partnership
formation
and
dissolution,
the
consideration
of
the
past
marital
history
will
become
even
more
important
for
future
cohorts
of
elders.
4.
Marital
status,
living
arrangements
and
mortality
A
particular
focus
within
work
on
marital
status
and
health
has
been
on
the
detrimental
effect
on
the
life
chances
of
men
who
remain
unmarried
or
experience
marital
dissolution
[2–4,31,32].
This
relationship
has
been
consistently
identified,
within
the
British
context
and
internationally.
Among
the
most
cited
papers
looking
at
mortality
differences
by
marital
status
is
that
by
Gove
which
paid
particular
attention
to
the
adverse
mortality
outcomes
for
single
men
relative
to
women.
It
is
argued
that
the
differences
in
mortality
can
be
attributed
to
the
characteristics
associated
with
psychological
state.
Men
living
alone
are
more
likely
to
be
lonely
than
women
with
similar
part-
ner
histories
[33].
Among
recent
analysis
using
a
cross-national
approach,
Murphy
et
al.
found
that
the
mortality
advantage
of
mar-
ried
persons
continues
up
to
the
oldest
age
groups
(85–89)
and
that,
the
largest
absolute
differentials
in
mortality
levels
between
marital
statuses
are
at
higher
ages
[34].
This
finding
parallels
other
work
describing
the
“powerful
and
pervasive
health
benefits”
of
marriage
at
older
ages
(Pienta
et
al.
[35],
p.
583).
Murphy
et
al.
find
that
over
the
1990s
the
advantage
of
married
people
increased
for
almost
all
the
countries
studied.
An
increasing
body
of
work
has
used
long-term
marital
history
to
account
for
current
mortality
[14–16].
Given
increasing
cohabitation
and
rising
divorce
at
older
ages,
the
consideration
of
cohabitation
at
older
ages
is
an
important
con-
tribution
to
the
literature.
Lund
et
al.
studied
mortality
in
relation
to
cohabitation,
living
with
or
without
a
partner
and
marital
status,
and
demonstrated
that
in
Denmark
there
is
a
high
and
significantly
increased
mortality
for
persons
living
alone.
Compared
with
mari-
tal
status,
cohabitation
status
was
a
stronger
predictor
of
mortality,
and
no
age
or
gender
differences
were
identified
[36].
In
the
context
of
other
work
focusing
on
a
person’s
lifetime
marital
history
[15],
this
paper
highlights
the
weakening
of
marital
status
as
an
indica-
tor
of
health
status
over
time,
and
suggests
that
a
broader
measure
of
partnership
or
living
arrangements
may
be
a
more
effective
indi-
cator.
However,
Manzoli
et
al.
used
53
independent
comparisons,
mainly
in
Europe
and
North
America,
in
order
to
estimate
the
over-
all
risk
of
mortality
for
different
categories
of
marital
status
and
marriage
showed
a
significant
protective
effect
similar
in
magni-
tude
across
countries
[37].
Providing
important
insights
with
regard
to
mortality
after
the
death
of
a
spouse
is
work
by
Martikainen
and
Valkonen.
This
study
estimated
mortality
after
bereavement
of
a
spouse
for
the
entire
population
of
Finnish
men
and
women
aged
35–85.
In
the
first
six
months
after
the
death
of
a
spouse
an
excess
mortality
of
30%
for
men
and
20%
for
women
was
identified
which
was
separate
to
any
common
incident
or
illness
[38].
Given
the
increase
in
an
individ-
ual’s
mortality
after
the
death
of
their
spouse,
research
has
found
that
emotional
support
tends
to
decrease
such
risk
[39].
5.
Conclusions
Living
arrangements
and
marital
status
have
been
shown
to
have
a
significant
effect
on
a
person’s
health
and
mortality.
Section
2
discussed
changes
in
marriage
status
and
living
arrangements
in
mid
and
later
life.
Although
levels
of
solo
living
in
later
life
have
recently
declined
because
of
increasing
life
expectancy
meaning
that
partnerships
have
been
more
likely
to
survive
to
older
ages,
this
trend
may
be
expected
to
reverse
as
the
cohorts
currently
in
mid-life
(born
in
the
1950s
and
1960s)
enter
old
age.
These
groups
are
more
likely
to
have
experienced
partnership
dissolu-
tion
and
a
significant
proportion
of
those
living
solo
in
mid-life,
particularly
men,
have
never
partnered
[22].
Section
3
showed
that
negative
health
outcomes
have
been
consistently
identified
for
single
and
divorced
persons.
Within
this
research
area
the
weak-
ening
of
current
(cross-sectional)
marital
status
as
a
measure
in
relation
to
mortality
was
shown,
and
the
merits
of
a
life
course
or
long-term
marital
history
perspective
were
illustrated
through
the
work
of
Grundy
and
Tomassini
[14].
In
the
last
section,
it
was
shown
that
research
has
consistently
identified
an
adverse
mor-
tality
risk
for
men
who
remain
unmarried
or
experience
martial
dissolution.
Research
on
the
relationship
between
marital
status
and
health
is
complicated
by
data
limitations,
especially
with
regard
to
the
timing
of
events,
uncertainty
on
exposure
for
identification
of
‘effects’,
multiple
transitions
associated
with
events
(e.g.
separated
to
divorced)
and
mediating
factors
(employment,
general
state
of
the
economy).
Given
the
changes
in
living
arrangement
norms
among
younger
cohorts,
research
will
increasingly
need
to
make
use
of
longitudinal
data
in
order
to
embrace
a
wider
conceptualisa-
tion
of
partnership,
living
arrangements
and
marital
status
and
to
take
into
account
changes
in
living
arrangements
and
the
long-term
impacts
of
transitions.
This
paper
has
argued
that
with
changes
in
marital
status
and
living
arrangements
taking
place
at
middle
and
older
age,
future
research
will
need
to
consider
the
longitu-
dinal
living
arrangements
and
partnership
status
of
older
people
in
the
context
of
their
life
course
to
fully
account
for
the
health
and
mortality
outcomes
of
different
living
arrangements.
Indeed,
Murphy
et
al.
identified
that
the
increasing
number
of
cohabiting
couples
at
older
ages
will
necessitate
use
of
de
facto
rather
than
de
jure
marital
status
in
the
future
[34].
Within
the
current
body
of
work
there
is
research
which
has
taken
long-term
marital
history
into
consideration,
notably
Grundy
and
Tomassini
and
Blomgren
et
al.
[14,15].
Although
at
the
current
time
marital
status
remains
an
important
health
and
mortality
predictor,
research
concerned
with
partnership
status
will
increasingly
need
to
consider
non-
marital
living
arrangements
such
as
‘living
apart
together’,
as
well
as
the
quality
of
the
‘marital’
relationship
and
those
who
maybe
thought
to
be
‘living
together
but
apart’.
The
country-specific
con-
text
of
such
living
forms
should
also
considered
in
analysis
using
living
arrangements.
Although
longitudinal
data
is
not
available
in
all
contexts,
the
richness
which
this
data
provides
for
research
on
the
relationship
between
marital
status,
and
health
and
mortality,
is
of
significance
for
research
in
this
area
and
will
need
to
be
further
utilised
in
the
future.
Contributors
The
authors
wish
to
acknowledge
the
support
of
colleagues
in
the
Engineering
and
Physical
Sciences
Research
Council
(EPSRC)
Care
Life
Cycle
(CLC)
project
(grant
number
EP/H021698/1)
and
the
Economic
and
Social
Research
Council
(ESRC)
Centre
for
Population
Change
(CPC)
(grant
number
RES-625-28-0001)
at
the
University
of
Southampton.
Competing
interests
None.

J.
Robards
et
al.
/
Maturitas
73 (2012) 295–
299 299
Provenance
and
peer
review
Commissioned
and
externally
peer
reviewed.
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